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Now That Grandma Has Been Vaccinated, May I Visit Her?

Now That Grandma Has Been Vaccinated, May I Visit Her?

The start of a mass coronavirus vaccination campaign at U.S. nursing homes has brought hope to many families. But it may be a while before restrictions loosen. Here are answers to common questions.

Vera Leip, 88, of Pompano Beach, Fla., received the Pfizer-BioNtech vaccine at the John Knox Village retirement community last week.
Vera Leip, 88, of Pompano Beach, Fla., received the Pfizer-BioNtech vaccine at the John Knox Village retirement community last week.Credit…Joe Raedle/Getty Images

  • Dec. 21, 2020, 4:48 p.m. ET

A watershed moment has arrived for many families: This week health care workers from CVS and Walgreens, under contract from the federal government, will fan out to nursing homes across the country to begin vaccinating residents against the coronavirus. The shots not only will help protect the nation’s elderly and infirm — and the staff who care for them — but they raise the prospect of ending the devastating isolation many residents have felt for months.

Family members are hopeful that before too long, they will return to visiting parents and grandparents, aunts, uncles and other loved ones regularly again. We checked with experts on some common questions.

Will restrictions on visiting be lifted soon?

Probably not in a big way. Restrictions vary by state, and the federal government’s guidance on what it considers safe stands for now. They already allow visits under certain conditions. The Centers for Medicare & Medicaid Services, or C.M.S., recommended in September that outdoor visits with residents be allowed and indoor visits, too, if the facility has been free of cases for 14 days.

Some medical experts have said that those guidelines are too lax and that visits should be severely restricted, even banned. However, some of these experts are now saying that the vaccine changes the equation, somewhat.

“Once all residents are vaccinated, it opens the door for loosening of restrictions,” said Dr. Michael Wasserman, the immediate past president of the California Association of Long Term Care Medicine, a geriatrician and former executive at nursing home chains.

To allow visits, Dr. Wasserman recommends all residents of a nursing home should be vaccinated (unless they have some condition or allergy that would discourage vaccination on medical grounds); all staff members should be vaccinated; the nursing home should have the ability to ensure that visitors test negative for the coronavirus and have been disciplined about wearing a mask in public settings.

Is the vaccine safe and effective for old and frail residents of nursing homes?

The clinical trials of the Pfizer and Moderna vaccine included people over 65, and results showed it to be safe and to work as well in older people as in younger ones.

“This vaccine has gone through testing and clinical trials to ensure it meets the highest safety standards. It also is safe to get if you already had the virus,” says a campaign to encourage people to get the shots by the American Health Care Association and National Center for Assisted Living, a combined trade group representing nursing homes and assisted-living communities.

The lead administrator for C.M.S., Seema Verma, reinforced the confidence in the shot for older patients, including those with health conditions, in a statement last week: “I urge states to prioritize nursing homes and vulnerable seniors in their distribution of the vaccine.”

The point is echoed by Dr. Sabine von Preyss-Friedman, chief medical officer of Avalon Health Care Group, which operates nursing homes, who said the new vaccines appear “safe and effective.”

If restrictions are eased, should I visit right away?

The Pfizer and Moderna vaccines both require two injections — the initial shot and a booster three or four weeks later. Dr. von Preyss-Friedman recommends waiting at least two weeks after the second shot to have a visit.

“You hope these vaccines work, but these are elderly patients,” she said. “You want to err on the side of protection.”

She said that, ideally, the visitor would also be vaccinated as well. Since shots won’t be widely available for a few months, it may be best to wait until you get your vaccine. Until then, she believes nursing homes should consider visits on a case-by-case basis.

Would visitors still need to wear a mask?

Absolutely, medical experts said. This is particularly true if they are not vaccinated, but even after they are vaccinated “until rates in the community go down,” said Dr. Joshua Uy, a geriatrician and associate professor at the University of Pennsylvania Medical School and the medical director of Renaissance Healthcare & Rehabilitation Center, a nursing home in Philadelphia.

Dr. Uy said that he hopes that the federal government would supply enough personal protective equipment so that all visitors and residents could be properly gowned for such visits.

What is being done to encourage nursing home residents to get vaccinated?

The combined nursing-home and assisted-living trade group has started a program aimed at helping nursing homes and other care facilities to explain to residents the essential need to get the vaccine. The campaign, #getvaccinated, notes: “The elderly population has a much higher risk for getting very sick, being hospitalized, or dying from Covid-19. The vaccine has been shown to provide a great deal of protection against serious illness due to Covid-19.”

But the people they love most may have more effective persuasive powers. Families can help, Dr. Uy said, by encouraging their parents and grandparents in nursing homes to get vaccinated.

“The vaccine,” he said, “is going to be our way out.”

Frontline Workers and People Over 74 Should Get Shots Next, CDC Panel Says

Frontline Workers and People Over 74 Should Get Shots Next, CDC Panel Says

The recommendation was a compromise aimed at getting the coronavirus vaccine to the most vulnerable of two high-risk groups.

Director of nursing education Loraine Hopkins Pepe, left, administers the Pfizer BioNTech COVID-19 vaccine to Dr. Richard Fine, head of anesthesiology, at Einstein Medical Center in Philadelphia, PA.
Director of nursing education Loraine Hopkins Pepe, left, administers the Pfizer BioNTech COVID-19 vaccine to Dr. Richard Fine, head of anesthesiology, at Einstein Medical Center in Philadelphia, PA.Credit…Hannah Yoon for The New York Times
  • Dec. 20, 2020, 3:40 p.m. ET

Striking a compromise between two high-risk population groups, a panel advising the Centers for Disease Control and Prevention voted Sunday to recommend that people 75 and older be next in line to receive the coronavirus vaccine in the United States, along with about 30 million “frontline essential workers,” including emergency responders, teachers and grocery store employees.

The debate about who should receive the vaccine in these early months has grown increasingly urgent as the daily tally of cases has swelled to numbers unimaginable even a month ago. The country has already begun vaccinating health care workers, and on Monday, CVS and Walgreens were to begin a mass vaccination campaign at the nation’s nursing homes and long-term care facilities. This week roughly six million doses of the newly authorized Moderna vaccine are to start arriving at more than 3,700 locations around the country, including many smaller and rural hospitals.

The panel of doctors and public health experts had previously indicated it would recommend a much broader group of Americans defined as essential workers — about 87 million people with jobs designated by a division of the Department of Homeland Security as critical to keeping society functioning — as the next priority population and that elderly people who live independently should come later.

But in hours of discussion on Sunday, the committee members concluded that given the limited initial supply of vaccine and the higher Covid-19 death rate among elderly Americans, it made more sense to allow the oldest among them to go next along with workers at the highest risk of exposure to the virus.

Groups of essential workers, such as construction and food service workers, the committee said, would be eligible for the next wave. Members did clarify that local organizations had great flexibility to make those determinations.

“I feel very strongly we do need to have that balance of saving lives and keeping our infrastructure in place,” said Dr. Helen Talbot, a member of the panel and infectious-disease specialist at Vanderbilt University.

Together, the two groups the committee voted to prioritize on Sunday number about 51 million people; federal health officials have estimated that there should be enough vaccine supply to inoculate all of them before the end of February.

Still, as the first week of vaccinations in the U.S. came to a close, frustrations were flaring about the pace of distribution. Some 128,000 shots had been given in the as of Friday, according to a New York Times database tracking vaccinations — a total that was just slightly more than half the number of new cases reported across the country that same day.

This weekend Gen. Gustave F. Perna, who heads the Trump administration’s distribution effort, apologized for more than a dozen states learning at the last minute that they would receive fewer doses next week of the vaccine manufactured by Pfizer than they had expected. Tensions were also broiling in some states over local decisions regarding which health care workers should get their shots immediately and which should wait.

The director of the C.D.C., Dr. Robert Redfield, will review the panel’s recommendation and decide, likely by Monday, whether to embrace it as the agency’s official guidance to states. The panel, the Advisory Committee on Immunization Practices, emphasized that its recommendations were nonbinding and that every state would be able to fine-tune or adjust them to serve the unique needs of its population.

The 13-to-1 vote came as frustrations flared about the pace of vaccine distribution. Some 128,000 shots have been given in the first five days of the vaccine United States, according to a New York Times database tracking vaccinations — just slightly more than half the number of new cases reported across the country on Friday alone. This weekend, Gen. Gustave F. Perna, who heads the Trump administration’s distribution effort, apologized for at least 14 states learning at the last minute that they would receive fewer doses of the vaccine manufactured by Pfizer next week than they had expected. Tensions were also flaring in some states over local decisions regarding which health care workers should get their shots immediately, and which should wait.

In addition to teachers, firefighters and police, a subgroup of the committee suggested that “frontline essential workers” should include school support staff; day care, corrections personnel, public transit, grocery store and postal workers; and those in working in food production and manufacturing. But the group’s official recommendation is not that specific.

Originally, the committee had signaled last month that they had been inclined to let 87 million essential workers receive vaccines ahead of adults 65 and older. Many had expressed their alarm that essential workers, who are often low-wage people of color, were being hit disproportionately hard by the virus and additionally were disadvantaged because of their lesser access to good health care.

general population.”

Answers to Your Questions About the New Covid Vaccines in the U.S.

Answers to Your Questions About the New Covid Vaccines in the U.S.

Vaccines are rolling out to health workers now and will reach the arms of the rest of us by spring. Here’s what you need to know.

The Pfizer-BioNTech Covid vaccines are prepared to be shipped at a Pfizer plant on Dec. 13, 2020 in Portage, Michigan.
The Pfizer-BioNTech Covid vaccines are prepared to be shipped at a Pfizer plant on Dec. 13, 2020 in Portage, Michigan.Credit…Pool photo by Morry Gash
  • Dec. 14, 2020, 1:47 p.m. ET

Getting the vaccine

Why can’t everyone get the vaccine now?

There aren’t enough doses for everyone, so initially the vaccine will be rationed for those who need it most. It will take time to produce and distribute the vaccine, and then schedule two vaccinations per person, three to four weeks apart. As more vaccines get approved, things will speed up. At least 40 million doses (enough for 20 million people) should be available from Pfizer and Moderna by the end of the year, and much more will come in 2021. How many doses will your state get? Look up your state’s vaccine distribution plans here. —Abby Goodnough

Who will get the vaccine first?

Here’s the expected order for vaccinations:

  • Health care workers and people in long-term care facilities: The nation’s 21 million health care workers and three million mostly elderly people living in long-term care facilities will go first, starting in December. Initially, there won’t be enough doses to vaccinate all health care workers, so states will prioritize based on exposure risk, choosing emergency room staff, for instance, to go first. Or they may offer the vaccine to the oldest health care workers first.

  • Essential workers: The 87 million Americans who work in food and agriculture, manufacturing, law enforcement, education, transportation, corrections, emergency response and other sectors, likely will be second in line, starting early next year. States will set priorities. Arkansas, for example, has proposed including workers in its large poultry industry, while Colorado wants to include ski industry workers who live in congregate housing.

  • Adults with underlying medical conditions and people over 65. Health officials are hoping to get any remaining older adults who have not been vaccinated sometime in the first quarter. Some states might decide to vaccinate residents over 75 before some types of essential workers.

  • All other adults. Adults in the general population are at the back of the line. They could start receiving the vaccine as early as April, said Dr. Anthony S. Fauci, the nation’s top infectious disease expert, although many people likely will have to wait until at least May or June. The vaccine hasn’t been approved in children, so it may be several months, or possibly a year, before the vaccine is available for anyone under the age of 16. —Abby Goodnough, Tara Parker-Pope

How will the first doses of the vaccine get to health workers?

Hospitals and medical groups are contacting health workers to schedule vaccine appointments. FedEx and UPS will transport the vaccine throughout most of the country, and each delivery will be followed by shipments of extra dry ice a day later.

Pfizer designed special containers, with trackers and enough dry ice to keep the doses sufficiently cold for up to 10 days. Every truck carrying the containers will have a device that tracks its location, temperature, light exposure and motion. Pfizer will ship the special coolers, each containing at least 1,000 doses, directly to locations determined by each state’s governor. At first, almost all of those sites will probably be hospitals that have confirmed they can store shipments at minus 94 degrees Fahrenheit, as the Pfizer vaccine requires, or use them quickly. —Abby Goodnough

How will the vaccine get to nursing homes?

The pharmacy chains CVS and Walgreens have contracts with the federal government to send teams of pharmacists and support staff into thousands of long-term care facilities in the coming weeks to vaccinate all willing residents and staff members. CVS and Walgreens are both planning to administer their first vaccinations on Dec. 21.

More than 40,000 facilities have chosen to work with CVS. Nearly 35,000 picked Walgreens. Each U.S. state has already picked, or will soon pick, either the Pfizer or the Moderna vaccine for all of its long-term care facilities that will be working with the pharmacies. —Rebecca Robbins, Abby Goodnough

How will the rest of us get vaccinated?

It’s likely that when the general public starts getting vaccinated in April, shots will be scheduled through doctor’s offices, CVS, Walgreens and other pharmacies — the same way people get flu shots. However, final plans will depend on what other vaccines besides Pfizer’s and Moderna’s have been approved. —Abby Goodnough, Rebecca Robbins

Can I choose which vaccine I get?

This depends on a number of factors, including the supply in your area at the time you’re vaccinated and whether certain vaccines are found to be more effective in certain populations, such as older adults. At first, the only choice will be Pfizer’s vaccine, though Moderna’s could become available within weeks. —Abby Goodnough

How long will it take to work?

You won’t get the full protection from the Pfizer-BioNTech vaccine until about a week after the second dose, based on clinical trial data. The researchers found that the vaccine’s protection started to emerge about ten days after the first dose, but it only reached 52 percent efficacy, according to a report in the New England Journal of Medicine. A week after the second dose, the efficacy rose to 95 percent. Read more here. —Carl Zimmer, Noah Weiland

Safety and side effects

Will it hurt? What are the side effects?

The injection into your arm won’t feel different than any other vaccine, but the rate of short-lived side effects does appear higher than a flu shot. Tens of thousands of people have already received the vaccines, and none of them have reported any serious health problems. The side effects, which can resemble the symptoms of Covid-19, last about a day and appear more likely after the second dose. Early reports from vaccine trials suggest some people might need to take a day off from work because they feel lousy after receiving the second dose. In the Pfizer study, about half developed fatigue. Other side effects occurred in at least 25 to 33 percent of patients, sometimes more, including headaches, chills and muscle pain.

While these experiences aren’t pleasant, they are a good sign that your own immune system is mounting a potent response to the vaccine that will provide long-lasting immunity. —Abby Goodnough, Carl Zimmer

How do I know it’s safe?

Each company’s application to the F.D.A. includes two months of follow-up safety data from Phase 3 of clinical trials conducted by universities and other independent bodies. In that phase, tens of thousands of volunteers got a vaccine and waited to see if they became infected, compared with others who received a placebo. By September, Pfizer’s trial had 44,000 participants; no serious safety concerns have been reported. — Abby Goodnough

If I have allergies, should I be concerned?

People with severe allergies who have experienced anaphylaxis in the past should talk to their doctors about how to safely get the vaccine and what precautions to take. Although severe reactions to vaccines are rare, two health care workers had anaphylaxis after receiving the vaccine on the first day it became available in Britain. Both workers, who had a history of severe reactions, were treated and have recovered. (Anaphylaxis can be life-threatening, with impaired breathing and drops in blood pressure that usually occur within minutes or even seconds after exposure to a food, medicine or substance like latex.) For now, British authorities have said the vaccine should not be given to anyone who has ever had an anaphylactic reaction, but U.S. health experts have said such warnings are premature because severe reactions can be treated or prevented with medications. Because of the British cases, the F.D.A. said it would require Pfizer to increase its monitoring for anaphylaxis and submit data on it once the vaccine comes into use. Fewer than one in a million recipients of other vaccines a year in the U.S. have an anaphylactic reaction, said Dr. Paul Offit, a vaccine expert at Children’s Hospital of Philadelphia.

Among those who participated in the Pfizer trials, a very small number of people had allergic reactions. A document published by the F.D.A. said that 0.63 percent of participants who received the vaccine reported potential allergic reactions, compared to 0.51 percent of people who received a placebo. In Pfizer’s late-stage clinical trial, one of the 18,801 participants who received the vaccine had an anaphylactic reaction, according to safety data published by the F.D.A. on Tuesday. None in the placebo group did. Read more here. — Denise Grady

What about my situation? Answers about different types of patients.

I had Covid-19 already. Do I need the vaccine?

It’s safe, and probably even beneficial, for anyone who has had Covid to get the vaccine at some point, experts said. Although people who have contracted the virus do have immunity, it is too soon to know how long it lasts. So for now, it makes sense for them to get the shot. The question is when. Some members of the C.D.C. advisory committee have suggested people who have had Covid in the past 90 days should be toward the back of the line.Read more here. —Abby Goodnough, Apoorva Mandavilli

Will it work on older people?

All the evidence we have so far suggests that the answer is yes. The clinical trials for the two leading vaccines have shown that they work about the same in older people as younger people. As the vaccines get distributed, the vaccine makers and the C.D.C. will continue to monitor the effectiveness of the vaccine in people 65 and older who, because of age-related changes in their immune systems, often don’t respond as well to vaccination as younger people do. But just as certain flu vaccines have been developed to evoke a stronger immune response in older people, it’s possible that one of the new vaccines could emerge as a better option for this age group. It’s just far too soon to know. —Carl Zimmer

I’m young and at low risk. Why not take my chances with Covid-19 rather than get a vaccine?

Covid-19 is by far the more dangerous option. Although people who are older, obese or have other health problems are at highest risk for complications from Covid-19, younger people can become severely ill, too. In a study of more than 3,000 people ages 18 to 34 who were hospitalized for Covid, 20 percent required intensive care and 3 percent died.

And as many as one in three people who recover from Covid have chronic complaints, including exhaustion, a racing heart and worse for months afterward. Covid vaccines, in contrast, carry little known risk. Read more here. —Apoorva Mandavilli

Vaccinating pregnant women and children

What about women who are pregnant or breastfeeding?

Pregnant and breastfeeding women should consult with their obstetricians and pediatricians about whether to get the vaccine. The Pfizer vaccine has not been tested in pregnant women or in those who were breastfeeding, and federal health officials have not issued any specific guidance, other than allowing these women to be vaccinated if they choose. (The American College of Obstetricians and Gynecologists issued practice guidelines to help women and their doctors talk about vaccination.)

In the initial rollout, it will be mostly pregnant health care workers who must weigh the benefits and possible risks. By the time the vaccine is available to pregnant essential workers or to women in the general population, there should be a lot more data available.

Some experts said the virus itself poses greater risks to pregnant women than the new vaccine. Since the 1960s, pregnant women have been urged to receive vaccines against influenza and other diseases. These women are generally cautioned against live vaccines, which contain weakened pathogens — but the Pfizer vaccine does not contain live virus. Read more here.Apoorva Mandavilli

Does the vaccine affect fertility or miscarriage risk?

A false claim has been circulating online that the new vaccine will threaten women’s fertility by harming the placenta. Here’s why it’s not true.

The claim stems from the fact that the vaccines from Pfizer and Moderna cause our immune systems to make antibodies to something called a “spike” protein on the coronavirus. The false warnings about fertility are based on the claim that these antibodies could also attack a similar protein that is made in the placenta during pregnancy, called syncytin. In reality, the spike protein and syncytin are similar only in one very small region, and there’s no reason to believe antibodies that can grab onto spike proteins would lock onto syncytin.

What’s more, the human body generates its own supply of spike antibodies when it fights off the coronavirus, and there’s no sign that these antibodies attack the placenta. If they did, you’d expect that women who got Covid-19 would suffer miscarriages. But a number of studies show that Covid-19 does not trigger miscarriages. Read more here. —Carl Zimmer

When will vaccines be available for children?

So far, no coronavirus vaccine has been approved for children. New vaccines are typically tested on adults before researchers launch trials on children, and coronavirus vaccine developers are following this protocol. In September, Pfizer and BioNTech began studying their vaccine on children as young as 12. Moderna followed suit in December. If these trials yield good results, the companies will recruit younger children. The FDA will then have to review these results before the vaccines can get emergency authorization. Read more here.—Carl Zimmer

Why weren’t children included in the early studies?

Vaccines are typically tested on adults first in the interest of safety. But once a vaccine is shown to be safe and effective in adults, researchers have to run more trials on children to adjust the dosage for their bodies. Another factor in the wait for a vaccine for children is that they are far less likely to die from Covid-19 than adults are. The Centers for Disease Control and Prevention issued a report in September which concluded that, of more than 190,000 people who died in the United States with Covid-19, only 121 were under the age of 21. —Carl Zimmer and Katie Thomas

Life after vaccination

What if I forget to take the second dose on time?

Both the vaccines from Pfizer-BioNTech and from Moderna have two doses, with the booster shot coming a few weeks after the first. Pfizer-BioNTech’s second dose comes three weeks after the first, and Moderna’s comes four weeks later. The second dose provides a potent boost that gives people strong, long-lasting immunity.

If for some reason you fail to get the second shot precisely three weeks after the first, you don’t have to start all over again with another two-dose regimen. “The second dose can be picked up at any time after the first. No need to start the series over,” said Dr. Paul Offit, a professor at the University of Pennsylvania and a member of the F.D.A.’s vaccine advisory panel.

And while the two leading vaccines include a second dose, some future vaccine candidates may only require one dose. Johnson & Johnson, for example, is expecting data in January that will show whether its experimental vaccine works after a single dose. In case it doesn’t, the company has also started a separate trial using two doses. —Carl Zimmer, Tara Parker-Pope

If I’ve been vaccinated, will I still need to wear a mask?

Yes, but not forever. Here’s why. The coronavirus vaccines are injected deep into the muscles and stimulate the immune system to produce antibodies. This appears to be enough protection to keep the vaccinated person from getting ill. But what’s not clear is whether it’s possible for the virus to bloom in the nose — and be sneezed or breathed out to infect others — even as antibodies elsewhere in the body have mobilized to prevent the vaccinated person from getting sick.

The vaccine clinical trials were designed to determine whether vaccinated people are protected from illness — not to find out whether they could still spread the coronavirus. Based on studies of flu vaccine and even patients infected with Covid-19, researchers have reason to be hopeful that vaccinated people won’t spread the virus, but more research is needed. In the meantime, everyone — even vaccinated people — will need to think of themselves as possible silent spreaders and keep wearing a mask. Read more here. —Apoorva Mandavilli

Will my employer require vaccinations?

Employers do have the right to compel their workers to be vaccinated once a vaccine is formally approved. Many hospital systems, for example, require annual flu shots. But employees can seek exemptions based on medical reasons or religious beliefs. In such cases, employers are supposed to provide a “reasonable accommodation” — with a coronavirus vaccine, for example, a worker might be allowed to work if they wear a mask, or to work from home. —Abby Goodnough

How will we know when things are getting better?

The test positivity rate in your community will be an indicator of how things are going. This number is the percentage of overall tests given in a community that come back positive. The lower the number, the fewer new cases and the less likely you are to cross paths with someone who has the virus. “The best number is zero,” Dr. Fauci said. “It’s never going to be zero, but anywhere close to that is great.” —Tara Parker-Pope

When can we start safely doing normal things, like going to the movies or the theater?

Public health officials estimate that 70 to 75 percent of the population needs to be vaccinated before people can start moving freely in society again. If things go well, life could get a lot better by late spring and early summer. “It depends on the uptake of the vaccine and the level of infection in the community,” Dr. Fauci said.

Given the surveys so far showing significant public reluctance to get vaccinated, however, it may take awhile to see widespread community protection, he said: “If it turns out that only 50 percent get vaccinated, then it’s going to take much, much longer to get back to the kind of normality that we’d like to see.” —Tara Parker-Pope

Will these vaccines put a dent in the epidemic?

The coronavirus vaccines will be much less effective at preventing death and illness in 2021 if they are introduced into a population where the virus is raging — as is now the case in the U.S. A vaccine that’s 95 percent effective, as Moderna’s and Pfizer’s versions appear to be, is a powerful fire hose. But the size of a fire is still a bigger determinant of how much destruction occurs.

According to the authors of a paper in the journal Health Affairs, at the current level of infection in the U.S. (about 200,000 confirmed new infections per day), a vaccine that is 95 percent effective — distributed at the expected pace — would still not be enough to end the terrible toll of the virus in the six months after it was introduced. Almost 10 million or so Americans would still contract the virus, and more than 160,000 would die.

Measures that reduce the virus’s spread — like mask-wearing, social distancing and rapid-result testing — can still have profound effects. Public health officials hope that people will continue to take these precautions at least until the country reaches a vaccination rate of 70 to 75 percent. —David Leonhardt

Will I be required to provide proof of vaccination to travel?

In the coming weeks, major airlines including United, JetBlue and Lufthansa plan to introduce a health passport app, called CommonPass, that aims to verify passengers’ coronavirus test results — and perhaps soon, vaccinations. CommonPass notifies users of local travel rules — like having to provide proof of a negative virus test — and then aims to check that they have met them.

Although no plans are in place yet to require proof of vaccination for travel or other activities, electronic vaccination credentials could have a profound effect on efforts to control the virus and restore the economy. They could prompt more employers and college campuses to reopen. And developers say they may also give some consumers peace of mind by creating an easy way for movie theaters, cruise ships and sports arenas to admit only those with documented virus vaccinations. Read the full story. —Natasha Singer

How long will the vaccine last? Will I need another one next year?

That is to be determined. It’s possible that coronavirus vaccinations will become an annual event, just like the flu shot. Or it may be that the benefits of the vaccine last longer than a year. We have to wait to see how durable the protection from the vaccines is. Immunity from coronavirus infections appears to last for months, at least, so that may be a hint about vaccines. —Carl Zimmer

How the different vaccines work

How do these new genetic vaccines work?

The Pfizer-BioNTech and Moderna vaccines use a genetic molecule to prime the immune system. That molecule, known as mRNA, is packaged in an oily bubble that can fuse to a cell, allowing the molecule to slip in. The cell uses the mRNA to make proteins from the coronavirus, which can stimulate the immune system. While the immune protection from these vaccines may last for months or perhaps even years, their mRNA does not — it is destroyed by our cells within days. Although these are described as “genetic” vaccines, the vaccines don’t alter your genes in any way. —Carl Zimmer

What do the vaccine developers mean when they say their vaccines are 95 percent effective?

Vaccine developers test their vaccines in clinical trials. The fundamental logic behind these trials was worked out by statisticians over a century ago. Researchers vaccinate some people and give a placebo to others. They then wait for participants to get sick and look at how many of the illnesses came from each group.

In the case of Pfizer, for example, the company recruited 43,661 volunteers and waited for 170 people to come down with symptoms of Covid-19 and then get a positive test. Among those who got sick, 162 had received a placebo shot, and just eight had received the real vaccine. This result shows that receiving a vaccine dramatically lowered the chances of getting Covid-19 compared to receiving a placebo.

The difference is expressed as efficacy: the Pfizer-BioNTech vaccine has an efficacy rate of 95 percent. (If there were no difference between the vaccine and placebo groups, the efficacy would be zero. If none of the sick people had been vaccinated, the efficacy rate would have been 100 percent.) A vaccine’s efficacy rate and effectiveness rate are different: Efficacy is a measurement made within the strict confines of a clinical trial, whereas effectiveness refers to how a vaccine works in the real world. No one knows yet the true effectiveness of these new vaccines. —Carl Zimmer

Was the Pfizer vaccine part of the government’s Operation Warp Speed?

Pfizer did not accept federal funding to help develop or manufacture the vaccine, unlike front-runners Moderna and AstraZeneca. Pfizer did get a $1.95 billion deal with the government to deliver 100 million doses of the vaccine. The arrangement is an advance-purchase agreement, meaning that the company won’t get paid until they deliver the vaccines. Read more here. —Carl Zimmer and Katie Thomas

What does the rollout of the Pfizer vaccine mean for the other vaccines in the race?

Researchers were heartened by the strong results of the vaccine developed by Pfizer and BioNTech. “It gives us more hope that other vaccines are going to be effective too,” said Akiko Iwasaki of Yale University.

The Moderna vaccine, which is next in line for approval, has an efficacy rate of 94.5 percent, essentially the same as the Pfizer-BioNTech vaccine. A vaccine from AstraZeneca and the University of Oxford has shown confusing trial results, with efficacy rates between 60 and 90 percent, depending on the strength of the doses that volunteers received. And the French company Sanofi had a major disappointment in its early clinical trials, finding that its vaccine couldn’t provoke an immune response in people over 55. The company is now reformulating its vaccine to start new trials. —Carl Zimmer and Katie Thomas

Reporting contributed by:

Abby Goodnough, Carl Zimmer, Rebecca Robbins, Apoorva Mandavilli, Denise Grady Katie Thomas, Tara Parker-Pope, Noah Weiland, Natasha Singer, David Leonhardt, Roni Caryn Rabin, Julie Bosman, Reed Abelson and Richard Pérez-Peña

Moderna to Begin Testing Its Coronavirus Vaccine in Children

Moderna Plans to Begin Testing Its Coronavirus Vaccine in Children

The company said the trial would involve children ages 12 through 17.

The study will include 3,000 children, with half receiving two shots of the vaccine four weeks apart.
The study will include 3,000 children, with half receiving two shots of the vaccine four weeks apart.Credit…Cody O’Loughlin for The New York Times

By

  • Dec. 2, 2020, 2:13 p.m. ET

The drugmaker Moderna said on Wednesday that it would soon begin testing its coronavirus vaccine in children ages 12 through 17. The study, listed Wednesday on the website clinicaltrials.gov, is to include 3,000 children, with half receiving two shots of vaccine four weeks apart, and half getting placebo shots of salt water.

But the posting says the study is “not yet recruiting,” and Colleen Hussey, a spokeswoman for Moderna, said it was not certain when the testing sites would be listed or start accepting volunteers. A link on the website to test centers is not yet working, and Ms. Hussey said she was not sure when it would become active.

Moderna announced on Monday that data from its study in 30,000 adults had found its vaccine to be 94.1 percent effective, and that it had applied to the Food and Drug Administration for emergency authorization to begin vaccinating adults. If approval is granted, certain groups of high-risk adults, including people in nursing homes, could receive shots late in December.

But no vaccine can be widely given to children until it has been tested in them. Vaccines meant for both adults and children are generally tested first in adults to help make sure they are safe for pediatric trials.

Moderna’s vaccine has not yet been studied in children or pregnant women. In the new clinical trial in adolescents, girls past puberty will be tested before each injection to make sure they are not pregnant.

“Everyone anticipates that when we test this first in adolescents, then older children, then the real small kids, that the Covid vaccine will work,” said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University and an adviser on vaccines to the Centers for Disease Control and Prevention.

But children have more active immune systems than adults, and may have stronger reactions, including more fever, muscle and joint aches, and fatigue, Dr. Schaffner said.

“They may be more out of sorts than adults for a day or two,” he said. “You really do want to know, if it’s given in adolescents, what can parents expect? You really want to be able to tell them clearly how you might feel for 24 or 48 hours after you receive the vaccine. And obviously, we really want to be able to tell parents it works.”

If a child had intense side effects and parents were not prepared for it, they might be reluctant to go back for the second shot, Dr. Schaffner said.

Dr. Paul A. Offit, a vaccine expert at Children’s Hospital of Philadelphia, said that vaccines “for the most part” work equally well in children and adults. Occasionally, as with the hepatitis B vaccine, different doses are required, he said. Moderna will study the same dose in children that it has tested in adults.

Pfizer began testing its coronavirus vaccine in children as young as 12 in October. A large clinical trial found its vaccine to be 95 percent effective in adults, and the company has requested emergency authorization from the F.D.A. Britain approved the Pfizer vaccine for adults on Wednesday, the first country to do so.

AstraZeneca has also tested its vaccine in children, but not in the United States.

As vaccine studies have moved forward, rumors have spread on social media, particularly among people who oppose vaccines in general, that President-elect Joseph R. Biden Jr. plans to require vaccination for everyone, including children. His team has denied those claims, and Mr. Biden has said that he will rely on scientists’ advice for the best way to end the pandemic.

Long-Term-Care Residents and Health Workers Should Get Vaccine First, C.D.C. Panel Says

BREAKING

Long-Term-Care Residents and Health Workers Should Get Vaccine First, C.D.C. Panel Says

The C.D.C. director will decide by Wednesday whether to accept the recommendation. States aren’t required to follow it, but most are expected to.

Medics in Austin, Texas, on a call to a nursing home earlier this year. The C.D.C. panel voted to urge vaccinating of nursing home residents and health care workers first.
Medics in Austin, Texas, on a call to a nursing home earlier this year. The C.D.C. panel voted to urge vaccinating of nursing home residents and health care workers first.Credit…John Moore/Getty Images
Abby Goodnough

By

  • Dec. 1, 2020, 6:03 p.m. ET

WASHINGTON — An independent panel advising the Centers for Disease Control and Prevention voted Tuesday to recommend that residents and employees of nursing homes and similar facilities be the first people in the United States to receive coronavirus vaccines, along with health care workers who are especially at risk of being exposed to the virus.

The panel, the Advisory Committee on Immunization Practices, voted 13 to 1 during an emergency meeting to make the recommendation. The director of the C.D.C., Dr. Robert R. Redfield, is expected to decide by Wednesday whether to accept it as the agency’s formal guidance to states as they prepare to start giving people the shots as soon as two weeks from now.

“We are acting none too soon,” said Dr. Beth Bell, a panel member and global health expert at the University of Washington, noting that Covid-19 would kill about 120 Americans during the meeting alone.

States are not required to follow the panel’s recommendations, but they usually do. The final decision will rest with governors, who are consulting with their top health officials as they complete distribution plans.

The new recommendation is the first of several expected from the panel over the coming weeks, as vaccines developed by Pfizer and Moderna go through the federal approval process, on the thorny question of which Americans should be at the front of the long line to get vaccinated while supply is still scarce. The panel described it as an interim recommendation that could change as more is learned about how well the vaccines work in different age groups and how well the manufacturers keep up with demand.

The roughly three million people living in long-term care and those who care for them are a relatively clear target; 39 percent of deaths from the coronavirus have occurred in such facilities, according to an analysis by The New York Times. But states and health systems will ultimately have to decide which of the nation’s 21 million health care workers should qualify to receive the first doses, as there won’t be enough at first for everyone.

Pfizer and Moderna have estimated that they will have enough to vaccinate, at most, 22.5 million Americans by year’s end, with the required two doses, a few weeks apart. The C.D.C. will apportion the supply among the states, with the initial allocation proportional to the size of each state’s adult population.

The only member of the committee to vote against the recommendation was Dr. Helen Talbot, an infectious-disease specialist at Vanderbilt University, who expressed discomfort with putting long-term-care residents in the first priority group because the vaccines’ safety had not been studied in that particular population. “We enter this realm of ‘we hope it works and we hope it’s safe,’ and that concerns me on many levels,” she said before the vote.

But most panel members who offered opinions said they thought the high death rate among that group made it imperative to include it.

Dr. José Romero, the chairman of the panel, said that he felt strongly that its process had adhered to its core principles: “maximizing benefit and minimizing harm,” promoting justice and addressing health inequities. Dr. Beth Bell, the co-chair, acknowledged that all of the members would have liked more data from clinical trials but said that because of the pandemic emergency, “we need to act.”

The panel, whose 14 voting members have expertise in vaccinology, immunology, virology, public health and other relevant fields, has hinted that the next priority group it will recommend for vaccination — “Phase 1b” — will be so-called essential workers, a huge group numbering more than 85 million. A division of the Department of Homeland Security has come up with a list of workers states should consider counting in that group; it includes teachers and others who work in schools, emergency responders, police officers, grocery workers, corrections officers, public transit workers and others whose jobs make it hard or impossible to work from home.

Dr. Robert Redfield, the C.D.C. director, during an October briefing at the agency’s headquarters in Atlanta.
Dr. Robert Redfield, the C.D.C. director, during an October briefing at the agency’s headquarters in Atlanta.Credit…Jenni Girtman/EPA, via Shutterstock

After essential workers, the committee is leaning toward recommending vaccination of adults with medical conditions that put them at high risk of coronavirus infection, such as diabetes or obesity, and everyone over 65. But some states might diverge to an extent, possibly choosing, for example, to vaccinate residents over 75 and then some types of essential workers.

All other adults would follow the initial groups. The vaccine has not yet been thoroughly studied in children, so people under 18 would not be eligible yet.

For at least a month or two, there will not be nearly enough vaccine to cover everyone in the initial groups. Dr. Moncef Slaoui, who leads the Trump administration’s Operation Warp Speed, said Tuesday morning in an interview with The Washington Post that Pfizer and Moderna would be able to provide an additional 60 to 70 million doses in January “if all goes well.” Since each person gets two shots, that would only be enough for 55 million people at most through the end of January — about 22 percent of the nation’s roughly 255 million adults.

Production will continue to increase in February and March, Dr. Slaoui said, with the hope that two new vaccines, from AstraZeneca and Johnson & Johnson, will gain F.D.A. approval.

“So very quickly, we start having more than 150 million doses a month in March, April, May,” he added. He and other federal officials have said that the general public is likely to be able to be vaccinated by May or June.

The C.D.C. panel was originally not supposed to vote on its recommendations until after the F.D.A. had approved a vaccine. But it bumped up the timing to give states more guidance as they complete their distribution plans, which must be submitted to the C.D.C. on Friday.

On Tuesday, the group specifically suggested that within the long-term-care population, residents of nursing homes, who tend to be the most frail and susceptible to Covid, should get the first vaccines in the event that there aren’t enough, along with staff members who have not had the virus within the last 90 days.

Within the much larger category of health care workers, the panel said that health systems should consider prioritizing those who have direct contact with patients and their families and those who handle infectious materials. Dr. Nancy Messonnier, who leads the C.D.C.’s National Center for Immunization and Respiratory Diseases, told the panel that based on her recent conversations with state health officials, most states and large cities “believe they can vaccinate all of their health care workers within three weeks.”

But whether they reach that goal depends on how much vaccine they get, and how quickly. Gov. Andy Beshear of Kentucky told reporters on Monday that his state had more than 200,000 health care workers but would receive only 38,000 doses in its first shipment and that it might not get another for two weeks.

Long-term-care facilities include nursing homes, with about 1.3 million residents; assisted-living facilities, with 800,000 residents; and residential care facilities, which tend to be small and cater to specific populations. The federal government has contracted with CVS and Walgreens to deliver vaccines to most such facilities nationwide, with teams of pharmacists making three visits to each to ensure that every staff member and resident gets both an initial shot and a booster shot several weeks later.

Several members of the panel urged that small community doctors’ offices not be left off the initial priority list. “Transmission dynamics suggest providers who care for patients earlier in their course of illness may be at higher risk,” said Dr. Jeffrey Duchin, a member of the panel who is in charge of public health in Seattle and King County, Wash.

Dr. Grace Lee, a panel member and a pediatrics professor at Stanford, said special attention should be paid to health care workers in lower-paying positions, such as nursing assistants, food workers and janitors, who may fear for their job security if they push to secure a spot toward the front of the vaccination line.

I am very mindful of the equity concerns,” Dr. Lee said.

Jan Hoffman contributed reporting.

Who Will Get the Coronavirus Vaccine First?

After months of deliberation and debate, a panel of independent experts advising the Centers for Disease Control and Prevention is set to decide on Tuesday which Americans it will recommend to get the coronavirus vaccine first, while supply is still short.

The panel, the Advisory Committee on Immunization Practices, will vote in a public meeting on Tuesday afternoon, and it is expected to advise that health care workers be first in line, along with residents of nursing homes and other long-term care facilities. If the C.D.C. director, Dr. Robert R. Redfield, approves the recommendations, they will be shared with states, which are preparing to receive their first vaccine shipments as soon as mid-December, if the Food and Drug Administration approves an application for emergency use of a vaccine developed by Pfizer.

States don’t have to follow the C.D.C.’s recommendations, but most probably will, said Dr. Marcus Plescia, the chief medical officer for the Association of State and Territorial Health Officials, which represents state health agencies. The committee will meet again soon to vote on which groups should be next to receive priority.

Here are answers to some common questions about the vaccine and its distribution.

Who will get the vaccine first?

Based on its recent discussions, the C.D.C. committee will almost certainly recommend that the nation’s 21 million health care workers be eligible before anyone else, along with three million mostly elderly people living in nursing homes and other long-term care facilities.

A staggering 39 percent of deaths from the coronavirus have occurred in long-term care facilities, according to the committee. But there won’t be enough doses at first to vaccinate everyone in these groups; Pfizer and Moderna, the two companies closest to gaining approval for their vaccines, have estimated that they will have enough to vaccinate no more than 22.5 million Americans by January. So each state will have to decide which health care workers go first.

They may choose to prioritize critical care doctors and nurses, respiratory therapists and other hospital employees, including cleaning staff, who are most likely to be exposed to the coronavirus. Or they may offer the vaccine to older health care workers first, or those working in nursing homes, who are at higher risk of contracting the virus. Gov. Andy Beshear of Kentucky said on Monday that most of his state’s initial allocation would go to residents and employees of long-term care facilities, with a smaller amount going to hospital workers.

It’s important to remember that everyone who gets a vaccine made by Pfizer or Moderna will need a second shot — three weeks later for Pfizer’s, four weeks for Moderna’s.

Who gets it next?

The C.D.C. committee hinted last week that it would recommend essential workers be next in line. About 87 million Americans work in food and agriculture, manufacturing, law enforcement, education, transportation, corrections, emergency response and other sectors. They are at increased risk of exposure to the virus because their jobs preclude them from working from home. And these workers are disproportionately Black and Hispanic, populations that have been hit especially hard by the virus.

Individual states may decide to include in this group employees of industries that have been particularly affected by the virus. Arkansas, for example, has proposed including workers in its large poultry industry, while Colorado wants to include ski industry workers who live in congregate housing.

After essential workers, the priority groups likely to be recommended by the C.D.C. committee are adults with medical conditions that put them at high risk of coronavirus infection, and people over 65. But again, some states might diverge to an extent, choosing, for example, to vaccinate residents over 75 before some types of essential workers. All other adults would follow. The vaccine has not yet been thoroughly studied in children, so they would not be eligible yet.

If the C.D.C. director, Dr. Robert R. Redfield, approves the panel’s recommendations, they will be shared with states.
If the C.D.C. director, Dr. Robert R. Redfield, approves the panel’s recommendations, they will be shared with states.Credit…Stefani Reynolds for The New York Times

Who will make state-level decisions about priority groups?

Each state has a working group, composed largely of public health officials, that has been planning for months and making decisions about vaccination campaigns. Each state’s top health official and governor will probably sign off on final plans.

How long will states focus on one priority group before moving to the next in line?

States don’t need to reach everyone in one priority group before moving on to the next, according to the C.D.C. advisory committee. But more federal guidance is expected on the subject.

When will the first doses of a vaccine be shipped, and where will they go?

Federal officials have said they plan to ship the first 6.4 million doses within 24 hours after the F.D.A. authorizes a vaccine, and the number each state receives will be based on a formula that considers its adult population. Pfizer will ship special coolers, each containing at least 1,000 doses, directly to locations determined by each state’s governor. At first, almost all of those sites will probably be hospitals that have confirmed they can store shipments at minus 94 degrees Fahrenheit, as the Pfizer vaccine requires, or use them quickly.

When will a vaccine be available to the general public, and where will people receive it?

Federal officials have repeatedly suggested that people who are not in the priority groups — healthy adults under 65 who don’t work in health care or otherwise qualify as essential workers — should have access to the vaccine by May or June, because there will be enough supply by then. But a lot will have to go right for that to happen. One factor is whether, or when, other vaccines besides Pfizer’s and Moderna’s are approved.

Can employers like hospitals or grocery stores require their employees to be vaccinated?

Employers do have the right to compel their workers to be vaccinated. Many hospital systems, for example, require annual flu shots. But employees can seek exemptions based on medical reasons or religious beliefs. In such cases, employers are supposed to provide a “reasonable accommodation”; with a coronavirus vaccine, a worker might be allowed to wear a mask in the office instead, or to work from home.

Three companies have announced preliminary data indicating their vaccines are effective, and there are dozens of additional candidates in clinical trials. Can I choose which vaccine I get?

This depends on a number of factors, including the supply in your area at the time you’re vaccinated and whether certain vaccines are found to be more effective in certain populations, such as older adults. At first, the only choice is likely to be Pfizer’s vaccine, assuming it is approved. Moderna asked the F.D.A. for emergency authorization on Monday; if approved, it would most likely become available within weeks after Pfizer’s.

Are there any side effects from the shot?

Some participants in both Pfizer’s and Moderna’s trials have said they experienced symptoms including fever, muscle aches, bad headaches and fatigue after receiving the shots, but the side effects generally did not last more than a day. Still, preliminary data suggests that, compared with most flu vaccines, the coronavirus shots have a somewhat higher rate of such reactions, which are almost always normal signs that the body’s immune response is kicking in. At the meeting of the C.D.C. advisory committee last week, some members said it would be important for doctors to warn their patients about possible side effects and assure them of the vaccines’ safety.

How do I know it’s safe?

Each company’s application to the F.D.A. includes two months of follow-up safety data from Phase 3 of clinical trials conducted by universities and other independent bodies. In that phase, tens of thousands of volunteers get a vaccine and wait to see if they become infected, compared with others who receive a placebo. By September, Pfizer’s trial had 44,000 participants; no serious safety concerns have been reported.

The F.D.A. will also review the data for each vaccine seeking authorization and share it with its advisory committee, which will meet publicly — in the case of the Pfizer vaccine, on Dec. 10 — to ask questions and make a recommendation to the agency. The F.D.A. will then decide whether to approve the vaccine for emergency use.

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